I’ve seen an awful lot of insurance and political posts the last few months, ad nauseam. This isn’t going to be one of those. Just a rundown of what I’ve done/had/have/plan to have and how that affects transplant and life going forward. Keep in mind that just because I’m paranoid doesn’t mean they aren’t out to get me. 🙂 I played my cards well and I played them right (so far) to insulate myself from the ebb and flow of politics affecting healthcare.
I was on my parents’ insurance until I was 21. Yes, that used to be the old cut-off. Dad had various insurance companies through work my whole life and I believe the last was Prudential. As a kid, I wasn’t privy, nor burdened with their out-of-pocket expenses, but I’m not aware of anything not being covered up through then. I know that sometimes the 20% of the 80/20 was a stretch and I have no idea what their annual max was.
When I turned 21, I got a job at a hotel call center and got Cigna HMO. It worked great, which is wonderful, because I didn’t do any due diligence other than checking that my CF doctor was in the network. I had that job for a few months and moved to a startup with another insurance, but with every change of jobs in my 20s came a 90-day probation period where benefits aren’t allowed to be bought into. So I had COBRA several times, but this was to the tune of $100/mo back in the early 2000s.
Several jobs later, I landed on Aetna with a really good plan. It was something like $40/mo for me and when I got married, my wife and I together were about $100/mo. It was a $1,500 deductible and $3,000 annual maximum. Back in 2005 when I got the original plan, there was a $5M lifetime limit. Back then with what we made, those were small sacrifices to our lifestyle, but very doable… and since they didn’t change every year (remember when you weren’t issued a new policy every year?), as our income increased, it became less a part of our life.
When I left that company, I went on COBRA as I worked for a WordPress theme start-up in late 2008. They did offer insurance around New Year 2009, but we decided it was too risky, so I stayed on COBRA. The next month, on February 1st, we parted ways and I rolled out Petersen Media Group on Groundhog Day, 2009 (read: 8 years ago yesterday). At some point that month, we got a letter from my former employer who managed the COBRA that I hadn’t returned paperwork they sent and my policy had ended in January!
*enter full freak-out mode* *screaming, yelling, blaming, begging, crying, everything*
When I calmed down, I found out that Aetna offered what was called a HIPAA-guaranteed policy for individual policies. If you had continuous coverage and no 60-day lapse since last coverage, you were guaranteed issue with no pre-existing conditions. Of course, pre-existing conditions was never an issue with employer policies. They just didn’t exist – if you got on an employer group plan, anything wrong with you was covered. Now this was saying it’s the same thing… the group pays together to cover expensive customers.
If you can still get a job with benefits (those come with working full-time for a decent-sized company for at least 90 days), do it while you’re healthy enough- that insulates you from the pre-existing condition issue if that policy reverts to pre-2012. That includes all able-bodied CFers over 18.
So what started as something like a $413/mo policy with the previous deductible/max/lifetime, has increased every year between $40/mo and $160/mo but the deductible/max/lifetime didn’t change because they never issued me a new policy. Well, correction, in 2012, the lifetime max was killed because it had to conform to ACA rules, but that leads to another issue we experienced, but first a pseudo-political but logical explanation of our insurance decisions.
When ACA was signed, I decided that the system was set to fail at some point – and I did blog about that for written proof of this at this point, LOL – so we were dead set to pay whatever premiums came our way to keep our grandfathered plan. Every year at renewal, the letter said something like, “You’re paying a TON, are you sure you don’t want to shop the marketplace and use subsidies? Oh, but if you do, you can NEVER get this plan back. It’ll be gone forever and ever and ever, Amen.” So, we bit our lips and our lifestyle dropped year after year as our premiums rose until they match our mortgage. I’ve had the same plan, same account number, same coverages since 2009.
In 2012, all of a sudden, almost none of my CF nebulizer antibiotics were covered. We were looking at something ridiculous like $12,000/mo for the meds I’d always been on for $15-30 each. Full-blown freak-out again! We contacted the state insurance commissioner and opened a case and simultaneously started calling them every day to get an answer why things weren’t covered. Beating our heads against the wall would have made more progress… until I contacted Aetna on Twitter. I found intelligence! After a few days, the found the answer: the system had inadvertently converted my group to ACA plans! Yup… if we had switched to ACA, we’d have been screwed, that much was made abundantly clear to us in those conversations with the policy agents.
At least twice, but maybe it’s 3x now, we’ve received a letter in October that my plan will no longer be offered. Every time, they followed that letter with one a week or more later that said “oops, we were wrong.” One year we’d already bought a Humana plan and then we got an Aetna invoice the next month! “Oh, your plan is still active. Sorry.”
Fast forward to this year. They sent that letter/follow-up letter combo again. Then we got our increase letter and it wasn’t that bad. I’d already done doctor and med research on the plan I would get, but I also have confirmation that the plan would be replaced each year with a new premium/deductible/max each year. At this point, that plan is cheaper per annum than what I have now, but plotting those increases vs my premium increases, their lines will cross very, very soon.
Now that I’m done with the transplant evaluation the financial counselor already met with us. She had already run my insurance plan through the paces to see about coverage for the eval, transplant, and all of the meds I’d be on. She was, simply put, shocked how good the coverage was. Everything is going to be $15-$30 copays and my max is something we budget for in January each year, making the rest of the year free except visit and Rx copays (and premiums).
So that’s why I’m not freaking out. In summary: I never had pre-existing conditions because I always had employer plans with continuous coverage since 1999. I’ve worked the entire time and still am running Petersen Media Group with an individual policy that doesn’t get replaced with a new set of prices and rules each year… and that brings a level of peace that is hard to come by when facing a million dollar surgical event.
I kept my pre-ACA insurance because it was far better than any of the ACA options–and especially for the drug coverage. Migraine meds alone would cost me $1200/month without that. (Yes, $50 per tablet.) Even as expensive as the premiums are, the cost is less than what I’d have to pay for the meds. Now with the threat to the ACA, I’m more grateful than ever to have made the decision I did.
Yeah, eventually the lines of premiums and max-out-of-pocket will cross, but even then, is it going to be worth the unease of an unknown, untested policy? Not for me, especially when I get new lungs and meds that are unquestionably needed or it will be a quick, painful end.